Lateral tarsal strip through osteotomies for recurrent ectropion and eyelid laxity correction

Objective to present a surgical technique for treating patients with recurrent ectropion and severe lower eyelid laxity. Methods Lateral tarsal strip and canthal fixation by osteotomy was performed in 6 patients with recurrent ectropion and 1 patient with extreme lower eyelid laxity secondary to an anophthalmic socket. Preoperative and postoperative photographs were evaluated in order to assess the outcomes of the procedure. Patients were followed up 4 weeks, 6 months, 12 months and 24 months of the postoperative period. The initial symptoms of the patients were eye redness, epiphora, foreign body sensation, aesthetic complaints, and facial asymmetry. Symptoms and aesthetic results were assessed by questioning, photographs, and fluorescein and lissamine green stains taken in each visit. Results No postoperative complications were observed. No recurrence episodes were reported during the follow-up period and physical appearance improvement and symptom severity reduction were maintained during the observation. Conclusion Lateral tarsal strip through osteotomies is an effective surgical procedure for treating severe recurrent ectropion cases or lower eyelid laxity and could be considered as an alternative treatment option or even a primary surgical technique in selected difficult cases.

A case of a 22-year-old man with primary synovial sarcoma of the parapharyngeal space with an AR somatic mutation: A case report and review of the literature

This case report describes a 22-year-old man with a pharyngeal foreign body sensation arising from the left side of the postpharyngeal wall. Histological examination showed a biphasic pattern of epithelioid and spindle cells including glandular differentiation. The tumour was positive for vimentin and SS18-SSX, and the spindle cells were positive for bcl-2; in contrast, the epithelioid tumour cells were positive for pan-cytokeratin, epithelial membrane antigen and CD99. There was no INI-loss in tumour cells. Then, the presence of the SYT-SSX gene fusion was demonstrated by fluorescence in situ hybridization. In addition, androgen receptor gene somatic mutations were detected by next-generation sequencing. However, 6 months postoperatively, the patient had neither developed a recurrence nor received adjuvant radiotherapy and chemotherapy. Accurate diagnosis depends on morphological and immunohistochemical examination and a proper molecular analysis, and novel technologies can detect a wide variety of genetic alterations. Although androgen receptor somatic mutations cannot provide addition treatment at present, surgical resection with a clean margin and follow-up is an appropriate approach.

An Emerging, Neglected and Underestimated Zoonotic Parasitic Ocular Infestation: A Comprehensive Review on Thelaziasis

Human thelaziasis is an emerging insect-borne zoonotic ocular parasitic infestation, occur more commonly in rural communities with poor living and low socioeconomic living, and mainly affects the children and old age people, where humans live in close proximity with animals. Human thelaziasis is caused by both Thelazia callipaeda and Thelazia californiensis. T. callipaeda lives under the eye lids, nictitating membranes, orbit, conjunctival sac, lachrymal glands, and lacrimal ducts of cats, dogs, rabbits, horses, cattle, deer, badgers, monkeys, wolves, foxes (definitive hosts) and man being an accidental host. The vectors (intermediate hosts) are non-biting, tear-seeking, diptera flies of family Drosophilidae (fruit flies) Phortica variegata, which feeds on tears of their definitive hosts, including humans. Clinical manifestations include conjunctivitis, lacrimation, itching or pain with foreign body sensation, epiphora, follicular hypertrophy, and less often with severe signs and symptoms such as keratitis, photophobia, ectropion, corneal opacities (due to the migration of worm across the cornea), floaters within the eye chamber leading to visual impairment/blindness. The knowledge and scientific information on human thelaziasis is still unknown or relatively limited to many ophthalmologists and clinicians, and received little attention; hence this comprehensive and systematic review of human thelaziasis, is undertaken to highlight its importance and further research.

Management of Vataja abhishyanda (Allergic conjunctivitis) with Gutika anjana and Punarnavadi eye drops: A comparative clinical study

Background: Vataja Abhishyanda is characterized by Toda (Pricking pain), Sangharsha (foreign body sensation), Achchasruta (watery discharge), Alpa Shopha (mild chemosis), Vishushka Bhava (feeling of dryness), Parushya (roughness) etc which are very similar to the most of signs and symptoms of the Allergic Conjunctivitis. It is one of the most common type of eye allergy and is widely experienced by global population. Aims and Objective: . To evaluate and compare the efficacy of Punarnavadi eye drops and Gutika Anjana in the management of Vataja Abhishyanda(Allergic conjunctivitis). Materials and methods: Total 104 patients diagnosed with symptoms and signs of Vataja Abhishyanda were selected from the outpatient department of Shalakya tantra. The selected patients were assigned randomly into two groups, group A (Punarnavadi eye drop) having 51 and group B (Gutika Anjana) having 50 patients. Duration of treatment was 8weeks with follow up for one month after the trial. Result: In Group A, 96.08% got complete relief after the completion of treatment, 03.92% got marked improvement. In Group B, 98% got complete relief after the completion of treatment, 2% got marked improvement. Conclusion: Gutika Anjana shows better relief in all sign and symptoms on the basis of percentage. The reason may be Anjana has maximum absorption due to more contact of time with the tissue which is responsible for better bioavailability.

Frequently Experienced Problems in the Early Stages after Prescribing Rigid Gas Permeable Contact Lenses

Prescribing rigid gas-permeable (RGP) lenses involves a series of processes that determine the most appropriate final lens through the trial use of test lenses based on the results of slit lamp microscopy, measuring refraction and corneal curvature, and corneal topography. The final prescription is reached by judging the dynamic lens movement, adequacy of the tear layer around the lens, corrected vision, and quality of vision. Various problems are encountered soon after prescribing lenses, including foreign body sensation, tear hypersecretion, decreased visual acuity, blurring, visual acuity change, redness, dryness, sudden pain, lens centering, and lens fallout. Here, we examine these problems and how to solve them.

Atypical Christmas Eye Disease: A Case Report and Literature Review

Background: Christmas Eye Disease (CED), also known as the “Albury-Wodonga syndrome” or “Harvester's Keratitis”, is a seasonal acute corneal ulceration syndrome, which is geographically limited to Australia, specifically in the south-west region of New South Wales (NSW) and north-east region of Victoria. The mechanism of injury is unknown, but the secretions from native beetles of the genus Orthoperus have been implicated. There remains a dearth of literature on CED, particularly with atypical disease presentations. We present the first reported case of CED in the upper Blue Mountains Region, presenting atypically with mild pain and foreign body sensation. We also aim to explore the possible entomological precipitants of the disease. Case Presentation: A 77-year-old man with a 1-day history of a mildly painful red eye was found to have acute corneal ulceration. He experienced mild discomfort in his right eye while asleep and woke the following morning with persistent blur, foreign body sensation, and photophobia. He had no history of ocular trauma or chemical exposure. He reported going for daily bushwalks in the upper Blue Mountains region but did not recall any exposure to environmental or entomological precipitants. Clinical Findings and Outcomes: Slit-lamp examination revealed a substantial corneal epithelial loss in the right eye with fluorescein staining, revealing a characteristic ‘green splash’ over 90% of the cornea. Other clinical findings included marked corneal edema, moderate conjunctival injection, mild palpebral swelling, and mild papillae. No anterior uveitis was observed, and the posterior segment examination was normal. There was a considerable reduction in his right visual acuity from baseline. He was empirically treated with 1% tropicamide ocular drops, 1% chloramphenicol ointment, and lubricant ocular drops. The bacterial and viral conjunctival swabs were unremarkable. Clinical progression was self-limiting, and complete resolution of the ulcer was achieved after one month. Conclusion: CED is a clinical diagnosis, and medical practitioners should be aware of atypical features, such as the absence of debilitating pain. Additionally, our case demonstrates that the geographic distribution of CED appears to be far more extensive than previously thought, thereby raising the possibility of disease manifestation in regions not commonly associated with it. Entomological precipitants of this condition remain circumstantial and warrant further validation.

Effect of budesonide aerosol inhalation on postoperative complications and foreign body sensation in the throat of goiter resection patients

Purpose: To study the effect of budesonide aerosol inhalation on postoperative complications and foreign-body sensation in the throat of patients who underwent goiter resection.Methods: One hundred and twenty patients who underwent goiter resection at The Affiliated Hospital of Putian University (Fujian, China) from January 2019 to January 2020 were included in the study, and then equally and randomly assigned to groups A and B. During the perioperative period, group A patients were given budesonide aerosol inhalation, while group B patients received aerosol inhalation of equivalent volume of normal salineectively. Postoperative complication rate (CR), complication pain scores, scores on mucosal response in the throat, and scores on foreign body sensation in the throat were determined for both groups.Results: Postoperative complications in patients were hoarseness, sore throat and cough. Group A had significantly lower postoperative CR, lower complication pain scores, lower scores on mucosal response in the throat, and lower scores on foreign body sensation in the throat, when compared to group B (p < 0.001).Conclusion: Budesonide aerosol inhalation in patients who underwent goiter resection is effective in relieving throat injury from general anesthesia, minimizing likelihood of postoperative complications, and easing foreign-body sensation in the throat. Thus, this strategy may be suitable for the management of postoperative complications.

Lingual thyroid with absent thyroid gland in neck

<p class="abstract">Lingual thyroid is defined as an ectopic thyroid gland tissue located in the midline of the tongue base. Patients with lingual thyroid tissue usually present with symptoms such as dysphagia, choking, haemorrhage, dyspnea and occasionally life threatening airway obstruction. Lingual thyroid is a rare anomaly with an incidence of 1 in 3000 of the thyroid cases seen, with overall prevalence of 1 in 100,000. Here we presented a case with complaint of difficulty in swallowing and foreign body sensation throat. The intraoral examination showed spherical mass with 2 cm of diameter, covered with intact mucosa, located midline at base of tongue. She was diagnosed clinically as lingual thyroid and evaluated further. By proper transdisciplinary approach correct diagnosis can be made and patient can be managed. In present case, thyroid profile, USG neck and thyroid scintigraphy helped in diagnosis. Patient was managed medically with tablet levothyroxine which relieved her symptoms. Surgical management was not considered as patient improved with levothyroxine and surgical excision would have made patient further hypothyroid as there was no thyroid gland in neck.</p>

Conjunctivitis as a sign of persistent SARS-COV-2 infection? An observational study and report of late symptoms

Purpose To investigate if symptomatic conjunctivitis during the recovery phase of the disease could be associated to a persistent presence of SARS-CoV-2 in the upper respiratory tract. Secondary end points were to analyze the presence of SARS-CoV-2 in the conjunctiva of ocular symptomatic patients and to record the presence of ocular disturbances at this point of the disease. Methods An observational study including consecutive COVID19 patients treated at Humanitas Clinical and Research Hospital who were attending for nasopharyngeal swab to confirm the resolution of SARS-CoV-2 infection and end of isolation. We examined 129 consecutive patients from May to June 2020. The primary end point was to determine if symptomatic conjunctivitis at this point of the disease could be associated to a persistent presence of SARS-CoV-2 in the upper respiratory tract. Secondary end points were to analyze the presence of SARS-CoV-2 in the conjunctiva of ocular symptomatic patients and to record the presence of ocular disturbances at this point of the disease. Results One hundred twenty eight patients were included, 9.38% had conjunctivitis, none resulted positive to conjunctival PCR swab test, while two of them had positive nasopharyngeal result. Mean time elapsed since the first COVID-19 positive swab to the time of examination was 6 weeks ( ± 3). The only significant association was the presence of conjunctivitis with older age (65.3 ± 12.7 vs 56.7 + 13.5. p = 0.046). Nasopharyngeal swab resulted positive in 22 patients (17.19%). While 88 patients (68.2%) did not have any ocular complain during their COVID19 disease. The 40 patients (31.8%) reporting ocular disturbances complained about: redness (25.43%), tearing (19.53%), burning (18.35%), foreign body sensation (17.18%), itching (15.62%), and discharge (12.5%). Conclusion This study showed that late conjunctivitis cannot be considered as a marker of persistent infection when patients are sent to confirm the resolution of SARS-CoV-2 infection.

Giant Pharyngeal Recess Cyst: A Case Report

A pharyngeal recess cyst is a benign lesion, located at the nasopharyngeal recess with limited development. Pharyngeal recess cysts rarely occur. This case report describes a young male patient presenting with a foreign body sensation in the pharynx. Electronic nasopharyngoscope examination revealed a large nasopharyngeal cyst, whose root was located in the left pharyngeal recess. Complete surgical resection was performed, and the patient successfully recovered. Pharyngeal recess cysts are rare lesions that can be diagnosed based on imaging and endoscopy findings. It is treated surgically and has a favorable prognosis.